A review of the pros and cons of antidepressant medication for treatment of major depression appeared this past week in the journal Frontiers in Evolutionary Psychology. The authors, Paul W. Andrews, J. Anderson Thomas Jr., Ananda Amstadter, and Michael C. Neale, use an evolutionary perspective combined with medical data to evaluate whether prescribing antidepressants should be the first choice of doctors to treat depression, as it currently is. They conclude that antidepressant medication can do more harm than good, and should be reserved for only the most serious cases (you can read the full text here).
The authors point out that most antidepressant drugs disrupt the way the neurotransmitter serotonin is used in the brain. Since serotonin is very conserved across evolutionary time (it evolved at least 1 billion years ago), and it is involved in many important processes in the body, disrupting it could have major negative effects. Some of these effects are: causing neuronal damage, bleeding, stroke, low blood sodium, and adverse sexual effects.
The sexual side effects of antidepressants are pretty huge. The authors site one study (here) that found negative sexual side effects in 26-80% of patients taking antidepressants (depending on the drug) vs. patients on placebo. This meta-analysis considered several forms of sexual dysfunction: desire, arousal, and orgasm dysfunction.
Serotonin is also important in many aspects of reproduction (in humans and even worms). They can affect the patient’s feelings of love or attachment for their partner. They can even have an impact on sperm motility.
Besides all of the other negative side effects that have been shown with antidepressants, the sexual side effects are certainly something to think about. Would losing your interest in sex, or possibly compromising your ability to conceive, be more harmful than your current depression symptoms? It’s definitely worth thinking about if you’re considering treatment involving serotonin-disruptive drugs.
What do you think? Do we over-prescribe antidepressants? Have any of the side effects of these drugs kept you from taking them as treatment?
Andrews PW, Thomson JA Jr, Amstadter A, & Neale MC (2012). Primum non nocere: an evolutionary analysis of whether antidepressants do more harm than good. Frontiers in psychology, 3 PMID: 22536191